Aetna has announced an expansion of their “Third-Party Claim and Code Review Program” to take effect March 1, 2021. While details of the expansion are minimal at this time, we anticipate this will result in an increase in medical record requests and further scrutiny of claims in terms of coding requirements, medical necessity, etc. Aetna has confirmed that these new claim edits will be updated in the “prospective claims editing disclosure tool” that is accessed via the Availity Portal (that provides similar guidance for other payers’ coding edits).
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